No Statistical Difference Between Arthoscopic and Open Triangular Fibrocartilage Complex TearsThe triangular fibrocartilage is found on the wrist across the two bones in the forearm. The cartilage allows the arm to move smoothly. If this cartilage is torn, the injury can have severe effects on the use of the arm and hand. Currently, acute tears, ones that happened suddenly, are treated by bracing or casting the arm, or by surgery. Originally, the surgery was done with a traditional open incision, however, as arthroscopic surgery (a technique that uses tiny incisions to allow long, thin instruments and camera inside to do the repair) improved, it was used more often to repair this type of injury.
The results of arthroscopic surgery were mixed. While the surgery is less invasive than traditional surgery, the physicians felt that it was not as effective. The authors of this study wanted to compare the effectiveness of the open versus arthroscopic surgeries as there was no record of such a comparison having been done.
Seventy-five patients were studied: 36 had arthroscopic surgery and 39 had an open repair surgery. The hands were assessed by physical examination findings, which included the presence of wrist pain, grip strength, range of motion, and the whether the wrist joint was stable. Before surgery and at follow-up of between 33 to 55 months after surgery, the patients were re-examined and asked to complete some questionnaires: the Disabilities of the Arm, Shoulder, and Hand Score (DASH) - which measures on a score of 0 to 100 the patient's own assessment of how the injury has impacted his or her life, the Patient Reported Wrist Evaluation (PRWE) - which is composed of two sections that evaluate pain and function from the patient's perspective, from 0 to 150 with 0 being normal, and the Visual Analog Scale (VAS) - which is for rating pain on a scale of 0 to 10, with 0 being no pain. The researchers used a scale called the Mayo Modified Wrist Score (MMWS), which measures on a scale of one to 100, with 100 being normal wrist function.
Before surgery, the MMWS was an average of 65.6 in the open surgery group and 63.5 in the arthroscopic group. Joint instability was present in 27 of all the patients, with no difference between groups.
After surgery, all patients had their arms splinted to prevent the forearm from rotating and this was for a period of five to six weeks. The average MMS after surgery was 71.2 in the open surgery group and 60.6 in the arthoscopy group. Pain in the open group improved by an average 10.9 points in the open group and 11.1 points in the arthroscopy group. Function improved by an average of 13.1 points in the open group and 12.3 points in the arthroscopy group. When the researchers evaluated grip and function, the differences in improvement between the two groups was not statistically significant.
In the past, reoperations were sometimes necessary for this type of surgery. In this study, 17 percent of the patients needed reoperations because of instability, but there was no difference between whether they were part of the open or arthroscopy group. The researchers did find that more females than males needed repeat surgery.
The authors concluded that there was no big difference between either technique, although there was a bit of a higher rate of pain after surgery in the open group (14 out of 39 patients) compared with the arthroscopy group (eight out of 36 patients).
Meredith L. Anderson, MD et al. Clinical Comparisons of Arthroscopic Versus Open Repair of Triangular Fibrocartilage Complex Tears. In Journal of Hand Surgery. June 2008. Vol. 33. No. 5. Pp. 676-682.
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